Two Different Therapeutic Modalities in the Treatment of the Upper Extremity Deep Vein Thrombosis: Preliminary Investigation With 20 Case Reports

Primary or secondary axillary or/and subclavian vein thrombosis (ASVT) can produce long-term disability, mostly in young patients, while the final vein recanalization after various therapeutic modalities often fails. Our aim was to compare the results of two different therapeutic modalities: the thrombolytic vs anticoagulant therapy, in primary and secondary ASVT in a retrospective data analysis in terms of efficacy, negative side effects, long-term positive results. Eleven patients (Group A), with primary and secondary to central venous cannulation or cardiac pacing ASVT, were treated with anticoagulant therapy, while another 9 patients (Group B), were treated with thrombolytic therapy, that included urokinase or streptokinase for 24-48 hours. The phlebographic, duplex ultrasonographic findings and clinical improvement were compared between the two patient groups. In Group A patients, after a mean period of 81.7 months follow-up (range 58-106), one patient with open vein were noticed, while in Group B patients after a mean follow up period of 52.1 months (range 35-68) five patients presented with recanalized veins (P = 0.040). Complete clinical recovery and vein patency was achieved in one Group A patient, contrary to 5 Group B patients (P = 0.040). When the patients with complete clinical recovery were combined with those who presented some clinical improvement, four Group A patients and eight Group B had satisfactory outcome (P = 0.028). Thrombolytic therapy should be the treatment of choice in primary and secondary ASVT, in productive patients whose lifestyle depends on continued strenuous use of the involved limb with a reasonable medium-term life expectancy. The thrombolytic agents prevent the vein valves damage and malfunction, avoiding re-thrombosis related to venous reflux and stasis, preserving the valve functional integrity.